Evolution of Modern Acute Pathways to Evaluate Key Performance Indicators and Outcomes in Femoral Fragility Trauma.

Abstract

Aims/Background The prevalence of fragility neck of femur (NOF) fractures among the elderly poses significant healthcare challenges. The Best Practice Tariff (BPT) was introduced to improve care standardization and outcomes for these high-risk patients. This study evaluates the effectiveness of transferring NOF fracture management to a specialized facility, focusing on BPT adherence, efficiency, and patient outcomes. Methods Employing a mixed-method cohort design, the study contrasted retrospective data pre-transition with prospective data post-transfer from Queen Elizabeth Hospital Birmingham (QEHB) to Birmingham Heartlands Hospital (BHH). A pivotal change was the introduction of a standardized electronic NOF Fracture Proforma. Comparison of demographic data, BPT adherence, 30-day mortality and postoperative care was made. Results The move to BHH resulted in a significant rise in BPT compliance rising from 40.5% at QEHB to 59.9% at BHH (p < 0.001), as well as a higher percentage of patients reaching operating theatres within 36 hours (p < 0.001). Despite improved adherence and operational efficiencies, no statistically significant reduction in 30-day mortality was observed. Conclusion NOF fracture management relocation to BHH yielded higher BPT compliance and greater operational efficiency. The lack of significant mortality reduction underlines the multifaceted nature of influencing patient outcomes. Specialized, multidisciplinary care has the potential to elevate the standard of patient care for NOF fractures, but continuous service optimization is critical for significant outcome improvements.